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General NPI Number Information
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NPI Number | 1720362536
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Entity Type | Individual
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Provider Name | JULIE TEBBE MOYNIHAN M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 3456 MARTINGALE CT
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City | PORT ORANGE
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State | FL
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Zip | 32129-3138
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Country | US
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Telephone | 386-383-2976
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Fax |
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Provider Business Mailing Address
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Address Line | 349 HIGH TIDE LN
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-1141
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Country | US
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Telephone | 386-344-3021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-12281
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License Number State | FL
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